Thought it might be time to tell my story in this group. A little background. I'm 62 and have had Afib since the late 90's. I have alway been a very active athlete, especially cycling. I have cycled throughout Europe and log about 5000 miles/yr. In the late 90's I noticed that on successive days of cycling I was having difficulty keeping up with the group. Long story short, I eventually suspected I had Afib, which was confirmed by my GP and then my cardiologist that I had lone/paroxysmal afib. I do not tolerate beta blockers/Ca channel blockers since, as a cyclist they keep you from raising your heart rate. Also, even in afib my heart rate was not excessive. So I settled on trying low doses of propafenone. While the propafenone was never particularly effective, I muddled along with the occassional afib. Fortunately, it rarely occurred during rides, but most often after finishing rides during recovery. Over the years the frequency increased, so I eventually had an ablation performed by Dr. Hugh Calkins at Hopkins. Everything about the experience was great except for one thing, the ablation never really worked. In addition, I started to develop a second trigger which was a type of reflux after eating (though probably not acid reflux). As one might expect, over the years the frequency increased to the point where I finally considered another ablation this summer. I did a fair amount of on-line and literature research and decided there were two significant advances over the past several years that provided me with more hope. 1) FIRM ablation (mapping and ablation of stable rotors) and 2) contact force measurement such that now the EP can know how much force he is putting againt the atrial wall when the energy is delivered for the burn (a significant factor in produceing durable lesions). I then went about "inteviewing" 3 EPs over the course of the summer. I picked them because they all had different levels of agressivenes and 2 were part of the FIRM ablation trial. I eventually chose Vivek Reddy at Mt. Sinai. (BTW, I live in DC, but was comftable with the idea of having the ablation done in NY). If you are really interested in knowing what goes into the procedure, I would suggest that you google Dr. Reddy and his webcasts as he often does demonstation procedures live at the EP and Heart conferences. In meeting with Dr. Reddy, we agreed that really my only alternative was a second ablation and sooner than later. He described me as being somewhere between paroxysmal and persisten which he jokingly termed parox-persistent. Also to note, he is not as enthused about FIRM ablation as being the magic bullet. He says that follow up studies will soon be published to show that the results are not as strikingly positive as orignally thought in 2012. I ended up having my procedure on Dec 11 (exactly 3 weeks ago). Everything was very professional and well done. You are certainly getting among the top/experienced groups with Dr. Reddy and Mt. Sinai. Quick findings: My left pulmonary veins had reconnected, thus my symptoms (right side remained isolated). Left pulmonary veins were re-isolated, some work done on the posterial wall (not as much as he would have like because of esophagus issues (he actually machanically deviates the esophagus in addition to temperature monitoring. Also, a right atrial line as I also have shown flutter EKGs. Overall, I was very pleased with everything. I would be happy to discuss the pros and cons of working with Dr. Reddy (mostly pros). Of note, I did end up in the ER the morning after my discharge. I was having alot of pain when breathing. Had some fluid build up (not uncommon) and nothing that some lasix, prednasone, and percost couldn't take care of. We remained in NYC for about 4 days post-procedure which I definitly recommend if you are traveling for your procedure. So far, so good, Not a moment of afib/flutter, that I am aware of. I'm back up indoor cycling/training after 2 weeks and will head outdoors in another couple of weeks. We have a plan for weaning off the drugs over about a 3 week period. Please feel free to contact me if you have any questions about my experiences over the years.
Rob